Multidisciplinary care planning and teamwork in primary care

Mitchell, Geoffrey; Tieman, Jennifer; Shelby‐James, Tania

doi:10.5694/j.1326-5377.2008.tb01747.x

Cited by 82 publications

(79 citation statements)

References 8 publications

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“…These, in part, reflect some observations found in other reviews of IHC primary care health clinics and team orientated initiatives within hospitals [17, 18, 20]. …”

Section: Discussionsupporting

confidence: 81%

“…The themes that emerged from the interviews include shared vision or philosophy [17], the changes required to organisational arrangements to deliver IHC [18], the importance of co-location, the lack of formal structures within the IHC to facilitate collaboration, the lack of guidelines or protocols [19] and the desire to incorporate a viable research component within an IHC program but limited resources to do so [20]. These, in part, reflect some observations found in other reviews of IHC primary care health clinics and team orientated initiatives within hospitals [17, 18, 20].…”

Section: Discussionmentioning

confidence: 99%

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The process of care in integrative health care settings – a qualitative study of US practices

Grant

Bensoussan

2014

BMC Complement Altern Med

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BackgroundThere is a lack of research on the organisational operations of integrative healthcare (IHC) practices. IHC is a therapeutic strategy integrating conventional and complementary medicine in a shared context to administer individualized treatment. To better understand the process of care in IHC - the way in which patients are triaged and treatment plans are constructed, interviews were conducted with integrative health care leaders and practitioners in the US.MethodsSemi-structured interviews were conducted with a pragmatic group of fourteen leaders and practitioners from nine different IHC settings. All interviews were conducted face-to-face with the exception of one phone interview. Questions focussed on understanding the “process of care” in an integrative healthcare setting. Deductive categories were formed from the aims of the study, focusing on: organisational structure, processes of care (subcategories: patient intake, treatment and charting, use of guidelines or protocols), prevalent diseases or conditions treated, and the role of research in the organisation. The similarities and differences of the ITH entities emerged from this process.ResultsOn an organisational level, conventional and CM services and therapies were co-located in all nine settings. For patients, this means there is more opportunity for ‘seamless care’. Shared information systems enabled easy communication using internal messaging or email systems, and shared patient intake information. But beyond this infrastructure alignment for integrative health care was less supported. There were no use of protocols or guidelines within any centre, no patient monitoring mechanism beyond that which occurred within one-on-one appointments. Joint planning for a patient treatment was typically ad hoc through informal mechanisms. Additional duties typically come at a direct financial cost to fee-for-service practitioners. In contrast, service delivery and the process of care within hospital inpatient services followed a more formalised structure.ConclusionsIHC is a complex, emerging field with divergent meanings and interpretations. The structures and processes of the IHC entities reported provide insight to the variable ways in which IHC manifests whilst commonly holding a similar vision. This report contributes to understanding IHC, providing evidence for future planning, implementation and evaluation to meet patient needs and demands in this area.

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“…These, in part, reflect some observations found in other reviews of IHC primary care health clinics and team orientated initiatives within hospitals [17, 18, 20]. …”

Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

The process of care in integrative health care settings – a qualitative study of US practices

Grant

Bensoussan

2014

BMC Complement Altern Med

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“…Shared-care models of health care delivery are complex interventions in themselves that vary widely based on definitions and the number of components involved [29,30]. In this context, we attempted an ambitious programme that not only required care providers to change their daily practice and working relationships, but also required novel software to deliver the intervention.…”

Section: Discussionmentioning

confidence: 99%

The challenges of real-world implementation of web-based shared care software: the HopSCOTCH Shared-Care Obesity Trial in Children

Lycett

Wittert

Gunn

et al. 2014

BMC Med Inform Decis Mak

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BackgroundE-health initiatives hold promise to improve shared-care models of health care. In 2008–2011 we developed and trialled web-based software to facilitate a randomised trial of a shared-care approach for childhood obesity involving General Practitioners (GPs) working with tertiary specialists. We describe the software’s development, implementation and evaluation, and make recommendations for future e-health initiatives. The web-based software was designed with the goals of allowing both GPs and specialists to communicate and review patient progress; integrating with existing GP software; and supporting GPs to deliver the structured intervention. Specifically, we aimed to highlight the challenges inherent in this process, and report on the extent to which the software ultimately met its implementation and user aims.MethodsThe study was conducted at the Royal Children’s Hospital and 22 general practices across Melbourne, Australia. Participants comprised 30 GPs delivering the shared-care intervention. Outcomes included the following. (1) GPs’ pre-specified software requirements: transcribed from two focus groups and analysed for themes using content analysis. (2) Software implementation and performance based on the experience of the research team and GPs. (3) GP users’ evaluation collected via questionnaire. (4) Software usage collected via GP questionnaire and qualified through visual inspection of the software meta-data.ResultsSoftware implementation posed difficult and at times disabling technological barriers (e.g. out-dated hardware, poor internet connections). The software’s speed and inability to seamlessly link with day-to-day software was a source of considerable frustration. Overall, GPs rated software usability as poor, although most (68%) felt that the structure and functionality of the software was useful. Recommendations for future e-health initiatives include thorough scoping of IT systems and server speed, testing across diverse environments, automated pre-requisite checks and upgrades of processors/memory where necessary, and user-created usernames and passwords.ConclusionsGPs are willing to embrace novel technologies to support their practice. However, implementation remains challenging mainly for technical reasons, and this precludes further evaluation of potential user-specific barriers. These findings could inform future e-health ventures into shared-care, and highlight the need for an appropriate infrastructure.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN126080000553.

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“…Shared care depends on agreed roles and responsibilities, task delegation, implementation and review 23. None of this was consistently interpreted among the informants in our study.…”

Section: Discussionmentioning

confidence: 69%

Medicines management support to older people: understanding the context of systems failure

2014

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ObjectivesChanging demographics and pressures on the healthcare system mean that more older people with complex medical problems need to be supported in primary and community care settings. The challenge of managing medicines effectively in frail elderly patients is considerable. Our research investigates what can go wrong and why, and seeks insight into the context that might set the scene for system failure.SettingNorth London; a district general hospital and surrounding health authorities.Participants7 patients who had been admitted to hospital and 16 informants involved in their care.DesignPatients with preventable medication-related admissions were identified in an occurrence screening study. An accident investigation approach was used to create case studies from accounts of staff involved in each patient's care prior to their admission. Structured analysis of case studies according to the accident investigation approach was complemented by a separate analysis of interviews using open coding with constant comparison to identify and illustrate higher-level contextual themes.OutcomesThe study sheds light on care management problems, their causes and the context in which care management problems and their causes have occurred.ResultsCare management problems were rooted in issues with decision-making, information support and communications among staff members and between staff, patients and carers. Poor judgement, slips and deviations from best practice were attributed to task overload and complexity. Within general practice, at the interface with community services and with hospitals, we identified disruption to traditional intraprofessional and interprofessional roles, assumptions, channels and media of communication which together created conditions that might compromise patient safety.ConclusionsNew ways of working driven by the ethos of productivity are disrupting traditional intraprofessional and interprofessional roles, assumptions, channels and media of communication. Concomitant improvements in communications technology, process and protocol are urgently required to offset potentially serious risks to patient safety.

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Multidisciplinary care planning and teamwork in primary care

Cited by 82 publications

References 8 publications

The process of care in integrative health care settings – a qualitative study of US practices

The process of care in integrative health care settings – a qualitative study of US practices

The challenges of real-world implementation of web-based shared care software: the HopSCOTCH Shared-Care Obesity Trial in Children

Medicines management support to older people: understanding the context of systems failure

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